The role of gastrocnemius muscle flap for reconstruction of large soft tissue defects after infected total knee arthroplasty

While there are many reasons the medial gastrocnemius flap is often the favored treatment for soft tissue defects around the knee area, this flap has some disadvantages. Reduced volume at the distal part of the flap and a short reach complicate provision of sufficient coverage for soft tissue defects superior to the patella and the lateral knee. In order to overcome these shortcomings, we modified the typical surgical technique by combining a medial gastrocnemius muscle flap and a medial sural artery perforator flap. This approach was applied to four patients who had developed deep infections and skin and soft tissue defects around the knee joint after total knee arthroplasty. The surgeries were successful. Dead space was well-filled and wounds healed without complications in all patients. This modified medial gastrocnemius myocutaneous flap provides a new option for treating challenging skin and soft tissue defects caused by deep infection after total knee arthroplasty.

Download Full-text

Reconstruction of soft tissue defects following total knee arthroplasty

The Knee ◽

10.1016/s0968-0160(02)00010-8 ◽

2002 ◽

Vol 9 (3) ◽

pp. 215-219 ◽

Cited By ~ 38

Author(s):

Adnan Menderes ◽

Cenk Demirdover ◽

Mustafa Yilmaz ◽

Haluk Vayvada ◽

Ali Barutcu

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Soft Tissue Defects ◽

Total Knee ◽

Tissue Defects

Download Full-text

Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0037-1607060 ◽

2017 ◽

Vol 31 (08) ◽

pp. 723-729

Author(s):

Bishoy Gad ◽

Joseph Styron ◽

Mark Goergy ◽

Alison Klika ◽

Wael Barsoum ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Soft Tissue Defects ◽

Patient Factors ◽

Flap Coverage ◽

History Of ◽

Total Knee ◽

Tissue Defects

AbstractRevision total knee arthroplasty (rTKA) is a challenging problem in the setting of soft tissue defects. The purpose of this study was to evaluate patients who underwent rTKA requiring flap coverage and determine patient factors that predisposed them to failure. Forty-three consecutive patients (mean follow-up, 46.5 months) who underwent rTKA requiring flap coverage were retrospectively reviewed between January 1, 2000 and December 31, 2010. Sixteen of 43 patients experienced failure requiring either flap revision (n = 2) or above the knee amputation (n = 14). Patients with heart failure (p = 0.008), cancer (p = 0.049), or infection with Klebsiella pneumoniae (p = 0.002) had greater rates of failure. Smoking (p = 0.287), diabetes (p = 0.631), and flap type (p = 0.634, p = 0.801) were not associated with increased failure. Mean survival was 46.4 months. Survival of patients with a history of cancer (34.3 months) was less (p = 0.033) than those without (49.2 months). Flap coverage in rTKA is a viable limb salvage option for patients with soft tissue defects; however, failure rates are much higher than in patients not requiring flap coverage.

Download Full-text

Soft-tissue Defects After Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-15-00241 ◽

2016 ◽

Vol 24 (11) ◽

pp. 769-779 ◽

Cited By ~ 15

Author(s):

Daniel A. Osei ◽

Kelsey A. Rebehn ◽

Martin I. Boyer

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Soft Tissue Defects ◽

Total Knee ◽

Tissue Defects

Download Full-text

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review

The Journal of Knee Surgery ◽

10.1055/s-0039-1684012 ◽

2019 ◽

Vol 33 (07) ◽

pp. 732-744 ◽

Cited By ~ 1

Author(s):

Demetrius M. Coombs ◽

Jessica Churchill ◽

Paul Cartwright ◽

Morad Chughtai ◽

Assem A. Sultan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Case Series ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Flap Coverage ◽

Tissue Reconstruction ◽

Total Knee ◽

Tissue Defects

AbstractDeep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

Download Full-text